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Backup plans if individual mandate is struck down

Many see an auto-enrollment requirement as a viable option if individual mandate fails. | Reuters

Health care economists disagree on how effective the mandate would be, but they are united on at least one point: If the mandate goes and insurance companies still have to cover everyone with pre-existing conditions, a tidal wave of uncertainty — that great fear of actuaries — will crash down on the insurance industry and people’s premiums could shoot up to frightening levels.

That’s only a hypothetical, since the court could rule that the pre-existing condition coverage — along with a provision that bans insurers from basing premiums on people’s health status — has to go away if the mandate is unconstitutional. But if it gets rid of only the mandate, calls for action will echo through the halls of Congress.

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“If it’s as bad as I think it’s going to be — and I think the uncertainty it adds would be very, very bad — then we’ll need to try something else,” said Jon Gruber, an architect of the Massachusetts health reform law that is a model for the Affordable Care Act. “It would become a self-fulfilling prophecy. The actuaries would imagine the worst case and start projecting high premiums across the board.”

Gruber believes the individual mandate is the tried-and-true way to move people onto insurance rolls, but he would choose auto-enrollment as the second best option. He warns, however, that a loss of the mandate would be a major shock to a load-bearing piece of the health reform law.

Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush, said she thinks a combination of carrot-and-stick policies could do a better job of moving free riders into the insurance market than the mandate — “a terrible piece of policy,” she said.

Auto-enrollment could do a better job, Wilensky said, as could another option: strict late-enrollment penalties, in which people pay higher premiums if they don’t enroll in coverage as soon as they’re eligible. That’s an approach similar to those that have shown results in Medicare Part B and Part D.

Another alternative comes from Princeton sociologist Paul Starr, who was a senior health care adviser to President Bill Clinton. Under his proposal, people would have three options, not including the poor, who would be covered under health reform’s Medicaid expansion.

They could buy insurance, with subsidies if they qualify. They could pay an annual tax penalty for going uninsured. Or they could opt out with no penalty — but they couldn’t opt back in for five years. And those who opt out wouldn’t have the protections under the health reform law, meaning any insurance — if they could get it at all — could be prohibitively expensive.

Start from the beginning and create a law for the people instead of a law for a corrupt government and special interests. The politicians who voted for this Obamacare horror should hang their heads in shame.

Did you say something? I thought coverage for all, including previous existing conditions, would get affordable coverage. That sounds like a "for the people" law to me. Where is the "corrupt government and special interests? That would be what we have now, and a "for profit" healthcare industry. All that overhead, all those shareholders, it's a business now. This would all go away with a single payer system.

You sprout negative opinion hyperbole and use Sean and Bill logic. Good luck with that! How do you feel about Rush?

All BS, the congress failed in its speed to put the bill on the floor decided to leave out the clause that resricts the bill from being cancelled if any portion is thereby found unconstitutional or not lawfull, so there is no options to do anything if struck down by SCOTUS! All this talk is hype and rhetoric to distort the truth, take americans into an excuse mode and dump them down!

I love the Republican alternative. Why can't we just go back to the way it used to be when the poor had no coverage and we could just fool the American people by saying we would enact 'free market solutions'? Ahhhh, those were the good ol' days.

Virtualphil (#3), although coverage for pre-existing conditons will drive up private insurance premiums for all, I don't know of many who whould object to this. Under Obamacare, taxes will go up because of this, too. The problem with socialized medicine (Obamacare) is that everything suffers under it. England did it and Obama uses it as a shining example, despite the fact that England is now trying to 'go back--it is unsustainable'. Costs rise and services suffer. I can't speak for Sue, but, as for me, anyone who wants to bypass the Constitution I would call corrupt--the 14th Amendment doesn't speak to this huge gov't takeover no matter how hard they try. Also, 'affordable' is subjective. There has to be a way to ensure that medical services are available to all (we now have safety nets for those who can't pay), without straining the system to the point that rationing and death panels (yes, although not called death panels, they are in the bill) are required. If you won't read the bill, Google Paul Krugman death panels and Barney Frank death panels. Both these men are progressives--Frank wants it out of Obamacare but Krugman suggests that the panels will help the U.S. economy--let peoplel die and highly tax their estates. I'm not sure why you mention the personalities you did--either read the bill or listen to fellow progressives.

I get the sense reading these comments that the people who are against this Health Care Law are those same people who do not have Health insurance and the ones responsible for my rates going up every year in order to cover their emergency Hospital bills should they get sick. You can say whatever you want about Canada as a Country, but each and every one of their citizens is covered for their health needs.

Virtualphil (#3), although coverage for pre-existing conditons will drive up private insurance premiums for all, I don't know of many who whould object to this. Under Obamacare, taxes will go up because of this, too.

The way I see it is premiums will go down when everyone has insurance. The biggest reason is that insurance companies are capped and must spend 80-85% of your premium on services and with a greater number of people paying in I see two major things that will happen. With limited profitability they will be forced to lower premiums to hit this mark and also they will try to provide more services to increase and justify higher premiums. This is truly a win-win for most except the people who do not want to pay for insurance. These are still private insurance companies and far from socialized medicine. I see it as government protection from big business that our lives depend on.

This time no more Democrat BS as when they had a Supermajority and held closed door meetings where they excluded everyone by the far Left Wing radicals.

No more Christmas Eve midnight votes ramming unconstitutionality down the throat of the public.

The Democrats came in arrogant, cocky and way over-reached. Led by Obama's "Ill trump you all on that!" attitude.

Hahahahahahaa. Revisionist history. Republicans were invited to the negotiating table OVER AND OVER AND OVER AGAIN ... only for them to scream "SOCIALIST" and try to hijack negotiations with a "My way or the highway" approach.

The "Supermajority" lie reveals its ugly head again as you would have had to count Lieberman (who supported McCain and spoke at the republican national convention) and the BushDog dems who in any other point in our history would be known as "moderate republicans".

It should never had come to a christmas eve midnight vote. Republicans sabatoged the process over and over again from day 1. And how can you keep calling it "unconstitutional" when it's basically the same plan that the republicans pushed TWICE in 1993 and is basically Romneycare?

The republicans were and STILL ARE arrogant, cocky, and overreaching ....